Addiction & Recovery

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As Pot Smoking Rises, So Do Addiction Concerns

Nov 11, 2014

Yahoo.com - With medical marijuana use now legalized in nearly half the states in the U.S. — and recreational toking allowed in both Colorado and Washington — comes a growing buzz of concern about what more pot smoking might mean for the health of society at large. This week has already brought worry over the possibility of more traffic fatalities, with researchers divided on how the drug may or may not affect one’s driving skills. And now a small but striking study of marijuana’s addictive qualities and teens has been released, on Tuesday: It found that 40 percent of those in an outpatient treatment program for pot use exhibited withdrawal symptoms — a hallmark of drug dependence.

“There’s a lot of misperception out there that marijuana is not addictive,” lead researcher John Kelly, of the Massachusetts General Hospital Center for Addiction Medicine, told Yahoo Health. “But it produces both a physical and psychological dependence in a similar way to that of other drugs, along with its own characteristic withdrawal symptoms.” The most general hint of addiction tends to be the psychological craving for more, he said, caused by the physical, neurobiological change in the brain as it becomes accustomed to the presence of the drug

In the study, which looked at 127 adolescents between the ages of 14 and 19 being treated at an outpatient substance abuse clinic, 90 percent said marijuana was their drug of choice. All were assessed and surveyed — both right away and at 3, 6, and 12 months later — on aspects including whether or not they thought the drug was causing problems in their lives and various psychiatric symptoms. Eighty-four percent met diagnostic criteria for cannabis dependence, with 40 percent reporting withdrawal symptoms such as anxiety, irritability, depression and difficulty sleeping. Interestingly, Kelly said, of those who experienced withdrawal symptoms, the ones who were unconvinced that any of their problems were related to the drug had the toughest time quitting.

Though the study was a small one and covered ground about marijuana addiction that has been examined before, it’s notable both because of the length of the follow-up period and because the subjects were moderate addicts, requiring just outpatient care. Kelly explained that an impetus for the study, funded by the National Institute of Alcohol Abuse and Alcoholism and published online in the Journal of Addiction Medicine, was to add information about addiction to the discussion of legalization and its public health impacts.

“I think it is relevant,” Kelly said. “What we know with alcohol and tobacco will be true with any drug: Make it cheaper and more accessible and consumption goes up. Do we want to introduce another drug with potentially negative social and health effects? Do the benefits outweigh the costs? The debate needs to be fully informed, and we need the clinical side saying, ‘This is not a benign substance. It’s not cornflakes.’ The neurocognitive impacts, especially with teens, have been shown to have lifelong implications.” Legalization of marijuana, he noted, is sure to bring millions of new cases of addiction. “The rates of addiction and harm will go up, there’s no doubt about it,” he said. “People need to be prepared for that.”

But those lobbying for legalization find the warnings to be exaggerated and unfair.

“Context is necessary when discussing issues surround cannabis’ potential dependence liability,” Paul Armentano, deputy director of NORML (National Organization for the Reform of Marijuana Laws), the 44-year-old advocacy group for decriminalizing marijuana, told Yahoo Health in an email. “Do a minority of people who experiment with cannabis at some point in their lives exhibit symptoms of drug dependence? According to the National Academy of Science, Institute of Medicine [in a 1999 report], about nine percent do. But this percentage hardly justifies cannabis’ criminalization or its classification as a schedule I substance under federal law, a scheduling that defines the plant as possessing a ‘high potential for abuse’ equal to that of heroin. In fact, just the opposite is true.” Armentano argues that pot is actually far less addictive than either alcohol or tobacco, and that withdrawal symptoms tend to be short-lived.

Addiction expert Stanton Peele, a lawyer, psychologist and author, who wrote the classic book “Love and Addiction” and the 2006 article “Marijuana Is Addictive — So What?” said that legalization — which he believes to be inevitable — demands a delicate approach.

“If more of a substance is used, there are probably going to be more negative consequences. That’s kind of a no-brainer,” he told Yahoo Health. “We’re passing through an interesting period in America: We believe drugs are bad and dangerous, and at the same time, we’re legalizing them. The challenge here is making drug use socially acceptable.” Peele’s relatively radical idea of making the switch to legalization a successful one, he explained, is to start teaching kids how to smoke weed responsibly. He noted that it’s an approach that could help teens deal with alcohol, too, rather than letting them learn at frat parties. It’s a particularly important idea, he said, if the U.S. winds up going the way of Portugal, which decriminalized all illicit drugs in 2000.

“If we can’t figure out how to deal with drugs,” he said, “we’re doomed.”